Showcase Hospitals Local Technology Review Report number 6 Smartphone application for antibiotic prescribing The Healthcare Associated Infections (HCAI) Technology Innovation Programme The basic ways of preventing and reducing healthcare associated infections (HCAIs) are largely unchanged. New technologies and equipment can support HCAI prevention strategies by helping get things done differently, more swiftly or more reliably. The Department of Health has funded the HCAI Technology Innovation Programme 1. The Programme aims to • Speed up the development and adoption of technologies to further help combat HCAIs • Identify which new technologies provide the best value and will have the most impact The Showcase Hospitals Programme As part of the HCAI Technology Innovation Programme, Showcase Hospitals undertook local technology reviews of infection related products or technologies in which they have a specific interest. These are service evaluations, as defined by the Health Research Authority’s National Research Ethics Service, and therefore do not require Research Ethics Committee review 2. This service evaluation was undertaken in Imperial College Healthcare NHS Trust. 1 For further information on the Programme see http://www.hcai.dh.gov.uk See leaflet on defining research at http://www.nres.nhs.uk/news-andpublications/publications/general-publications/ 2 Acknowledgements This work was supported by the National Institute for Health Research Biomedical Research Centre Funding Scheme at Imperial College and the National Centre for Infection Prevention and Management (CIPM) funded by the United Kingdom Clinical Research Council (UKCRC). Showcase Hospitals report number Smartphone application for antibiotic prescribing Contents Executive summary 2 Introduction 3 The problem Antibiotic Prescribing 3 The product 3 The knowledge base What was known before this evaluation 4 Development and Implementation Introduction 4 Pre-development questionnaire 4 Application development 5 Launch and dissemination of the application 5 How acceptable was the application to staff? 5 Post-intervention additional functionality 6 National and local awards 6 Further development of the application 6 Advice for trusts considering introducing smartphone applications for the dissemination of policy and guidance 7 Cost comparison 7 Appendix 1 Pre-development Questionnaire 8 References 9 1 Executive summary As part of the Department of Health’s Healthcare Associated Infections (HCAI) Technology Innovation Programme, Showcase Hospitals undertook local technology reviews of infection related products or technologies in which they have a specific interest. The objective is to help Directors of Infection Prevention and Control and other stakeholders to decide whether they should consider any of these products or technologies as part of their Trust’s strategy to reduce Healthcare Associated Infections. The National Centre for Infection Prevention and Management (CIPM) and Imperial College Healthcare NHS Trust developed and implemented a clinical decision support smartphone application based on the Trust’s antibiotic prescribing Policy. This work was part-funded by the Showcase Hospitals programme and this report summarises the steps in the development and implementation process and key learning points for other organisations considering adopting similar technologies. CIPM worked in collaboration with an external developer to design a smartphone application in partnership with a team of researchers and clinicians at the Trust. The application is now widely adopted by clinicians and has received national interest and recognition winning both a national and local award. Keywords: antibiotic policy, smart phone application, eHealth 2 Introduction This report describes the development and implementation in Imperial College Healthcare NHS Trust, one of nine Showcase Hospitals, and the National Centre for Infection Prevention and Management (CIPM) of a smartphone application for the Trust’s antibiotic prescribing policy. The objective of this document is to help Directors of Infection Prevention and Control and other staff to decide whether they should consider using smartphone technology as a means of disseminating policy and guidelines in order to improve practice at point of care. It aims to highlight the potential for using the existing infrastructure of mobile technology for cost-effective point of care access to medical information and policy. The problem: Antibiotic prescribing Antibiotic prescribing is a High Impact Intervention 3, and the ‘need to get it right’ is essential not only in terms of successful treatment of the individual patient but to prevent the unwanted consequences of treatment failure, toxicity, emergence of Clostridium difficile disease and antibiotic resistance. The majority of antibiotic prescribing is undertaken by junior doctors not specialised in the treatment of infections. The quality of prescribing may suffer as, in order to ensure effective therapy and to cover the gaps that exist in their own knowledge, prescribers use broad spectrum agents for longer than necessary[1]. This sub-optimal prescribing decision process has resulted in widespread inappropriate use of antibiotics. The majority of prescribing errors in hospitals involve antibiotics [2] and it is estimated that up to 50% of antibiotic prescribing in acute care may be inappropriate[3]. Clinical decision support tools for antibiotic prescribing need to be developed to support prescribers at the point of care.[4] Evidence-based science should be used in conjunction with modern technology to make the most desired action the easiest to follow for prescribers. The product The CIPM commissioned an external software developer to work with CIPM researchers and clinicians to develop a smartphone application which would act as a mobile point of reference for evidence-based local antibiotic prescribing, with an incorporated decision support system to assist clinicians in delivering optimised antibiotic prescribing and effective monitoring. The Imperial Antibiotic Prescribing Policy (IAPP) smartphone application was developed in iterative stages. The final IAPP product was a mobile iteration of the Trust’s Treatment of Infection Policy (TOIP) pocket guide with additional 3 High Impact Interventions (HIIs) are an evidence-based approach that relate to key clinical procedures or care processes that can reduce the risk of infection if performed appropriately. See http://hcai.dh.gov.uk/whatdoido/high-impact-interventions/ 3